The in-Training Editors-in-Chief, Nihaal Mehta (NM) and Amelia Mackarey (AM), talked to Dr. Dustyn Williams (DW) and Jamie Fitch (JF), co-founders of OnlineMedEd — one of the most widely-used educational resources by medical students around the world — and two leading figures in shaping medical education. The conversation ranged from OnlineMedEd as a learning platform to Dustyn’s and Jamie’s philosophies on teaching and the future of medical student education.

You can also read parts one and two of this interview. Here, in part three, we talk about the growing emphasis placed on USMLE scores, whether you should use multiple resources to study in medical school, OnlineMedEd’s upcoming custom study schedule feature and if you should be prescribing Aliskiren (the answer is no).

NM: Do you think there is too much emphasis on teaching to the test in medical school, or do you that’s appropriate given the current reality of USMLE scores and residency applicants?

DW: That’s a dangerous question to answer because it can get misinterpreted. I think in the clinical years, you need to learn the classic illness scripts regardless of how inappropriate that illness script is to actual practice. There are still right and wrong answers.

“Teaching to the test” I interpret as teaching the foundational illness scripts. You have to know what CHF [congestive heart failure] presents like. If someone says CHF to me, it’s JVD [jugular venous distention], crackles, peripheral edema, dyspnea on exertion, orthopnea. If a medical student doesn’t have that already in their head, they can’t learn the latest recommendations: what beta-blocker to use and which dose, and should you use Aliskerin — the answer is no, by the way.

What I provide through OnlineMedEd and to my clerkship students is that foundational education — it is the right and wrong answers that are on the test. The reason I think that’s ok is because when you graduate medical school, you aren’t supposed to know everything. You’re supposed to have a solid foundation. Even if you’re a urologist, you should know to give aspirin to a [patient with] chest pain.

When you leave medical school and go to your residency, what you realize is it’s a lot more than OnlineMedEd. No kidding — pelvic anatomy is a 20-minute video [on OnlineMedEd]. Turns out there’s more to know than that. If you’re going to become a gynecologist who does surgery, you’re going to learn a hell of a lot more than I teach there.

My point is, teaching to the test, if interpreted as teaching the foundations, I absolutely agree with. Once the students have a strong foundation and move on, they can actually learn the details of their specialty.

JF: I think there’s a lot of responsibility for a platform like us just to teach the basics. It’s test prep but it’s giving you everything you’re going to need. Dustyn says, even in residency — I’m talking about those experts you have as faculty — it really allows those faculty to get into the discussions, the grays that are the real world, and to teach those nuances.

You need a central resource where you’re getting most of your information from, the 80-90% that builds your core. Everything else can be done in person — experiential — as you see a patient and learn the spectrum of disease. That’s what we’re trying to accomplish.

DW: That’s the concept of the advanced organizer. Everytime someone says “dyspnea,” I see a triangle in my head: acidosis and alkalosis on the top, blood drop on the second row and the bottom is the pulmonary stuff. I did that because I used the advanced organizers when I was in intern year. It was extra work and it took longer to write it out, but now I don’t have to write it out. Now, anytime I encounter anything on dyspnea — I hear a pulmonologist speak or I see a patient who’s not breathing correctly — I can come back to that advanced organizer. Every time I encounter something, I’m re-engaging those neurons, stimulating memory, so that it’s not just “this is COPD [chronic obstructive pulmonary disease], this is also COPD” — no, there’s a COPD central arc, and this person happens to be way off to the right. This is not normal, so I should be looking for something else.

To me, this is now intuitive. I can smell the infarct. I know before I walk in the room — when the intern begins the presentation I know if it’s bullshit or not. Learn the dyspnea pyramid so when you have your experiences, it builds on that and becomes intuitive much faster.

AM: As students, we have so many learning resources available to us — First Aid, UWorld, Pathoma, Sketchy — where do you see OnlineMedEd fitting in and how is it different?

DW: Once you get into clinical years and start using OnlineMedEd, you realize you don’t need anything else. We designed it to be the one stop shop. I call it “Alice syndrome” for people who have trouble organizing everything. I remember for Step 1, everyone had a recommendation. If you tried to use them all and got 10% from each, you didn’t do very well on Step 1.

What we do is provide the à la carte service. I don’t expect you to use everything on OnlineMedEd, but we provide them all to satisfy anyone’s learning style. If you have trouble, you can always follow our PACE paradigm strictly. Of all the people who’ve failed multiple Shelf exams, no one has failed after undergoing remediation.

OnlineMedEd is going to be the one-stop shop — you won’t have to use anything else. I don’t think I’m going to knock out anyone — if someone likes someone else’s style, use that. The point is, we want you to walk into medical school on day one knowing about OnlineMedEd and not needing anything else — other than your professor’s PowerPoint because they ask you what slide 6, line 4, word 3 is.

JF: There’s a couple universal truths that make us a little bit different. One is this idea that you need to learn what you need to learn, not what someone else needs you to learn, and not everything about everything. That’s Dustyn’s innate gift: the ability to distill complex topics down.

There’s this idea that OnlineMedEd is just meant to get you only 50% of the way there. But people that commit fully to the platform can get to a 270 just with that, because everything is efficient and effective and curated with a single voice. Dustyn’s not writing all the content, but he is overseeing it all and making sure it’s aligned, so there’s no dissonance between resources. Everything is aligned to one central course and circuit.

The technology is pretty good. The website is alright — it has time-based resources and we’re continuing to bring resources to focus on the technology to help you study. Right now, we give away free study guides. We’re creating a dynamic scheduler that will feed that content to you. You don’t have to think — you just say I’m taking Step 2 in 2 months, I’m looking to score this well and try this hard. I’m going to spend eight hours a day and I want a 250, or I want a 240 because I did well on Step 1. No problem. There’s an algorithm that’s going to generate a custom content schedule for you.

Since we have so many users on the website — over 100,000 per month — we’re crowdsourced, so as soon as something is outdated, someone tells us. OnlineMedEd is the most current website on the internet as far as the med ed content out there. We have a constant feedback loop of what’s right and what’s wrong.

DW: Students love to pick apart anything I say. If I misspeak by one base pair, I get 75 emails.

JF: *laughs* That’s true! As students they are particularly picky.

DW: People are like, well, are we learning the right thing, are we sure we can trust just you? What I say is, I’m not going to teach you everything about everything. You’re going to get a question you won’t get right. But the time it takes to learn everything about everything is just too daunting. Chances are, if you learn from us with the one curated voice and you get the same material four times in different perspectives, you’re far more likely to remember it, to make the right choice on the test, than if you just learned a lot about a lot of stuff.

What I tell people is, you could have used a different resource and maybe you would have gotten one [additional question correct]. But you would have had to have found it on OnlineMedEd, learned it incorrectly, and then have that question show up on the exam. What I’m saying is, the risk of using only one resource like ours is very low. You might miss something. But the benefit is high. Everything we do teach, you’re going to know and you’re not going to miss it. In terms of a test prep model, it’s actually better to use one resource than multiple.

Part four of our interview with Dr. Dustyn Williams and Jamie Fitch, co-founders of OnlineMedEd, is available here.

Nihaal Mehta is a member of the Class of 2020 at Brown University Alpert School of Medicine. Originally from Lexington, MA, he also attended Brown for college, graduating in 2014 with a degree in Health and Human Biology and subfocus in Global Health.
Nihaal’s interests lie in medicine and its intersections: with health systems, policy, and the humanities. In college, he worked as a Writing Fellow, a Teaching Assistant for biology and public health courses, and assisted in the design of a course that examines controversies in medicine. Before returning to Brown for medical school, he spent a year working in consulting on health care business, strategy, and policy. He plans to specialize in Ophthalmology, and has conducted research focused on optical coherence tomography and retinal disease.

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in-Training is the agora of the medical student community, the intellectual center for news, commentary, and the free expression of the medical student voice. We publish articles about humanism in medicine, patient stories, medical education, the medical school experience, health policy, medical ethics, art and literature in medicine, and much more.